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Anaphylaxis
(The Most Serious Allergic Reaction)
Causes - IgE Mediated Examples
Medications Penicillin, Cephalosporin,
Anesthetics, Streptokinase,
Others
Insect Stings Hornet, Wasp, Yellow Jacket,
Honey Bee, Fire Ant
Foods Peanuts, Treenuts, Fish,
Shellfish, Eggs, Milk, Soy,
Wheat
Vaccines Allergy Shots, Egg and
Gelatin based vaccines
Hormones Insulin, Possibly
Progesterone
Latex Rubber Products
Animal/Human Proteins Seminal Fluid, Horse Serum
(snake anti-venom)
Causes - Non IgE Mediated Examples
Medication Non-steroidal Anti-
inflammatories (Aspirin,
Motrin, etc.), Morphine,
Muscle Relaxants (Robaxin,
Norflex, and others), Gamma
Globulin
X-ray Dye
Preservatives Sulfites
Physical Exercise, Heat-Induced
Uticaria (Hives), Cold-
Induced Uticaria
Idiopathic Unknown Cause
Allergy Alert
If you develop flushing, itching, hives, or other allergy symptoms while exercising, STOP IMMEDIATELY. If this has happened before, always carry an emergency epinephrine injection with you and never exercise alone.
How do we manage anaphylaxis?
The optimal management of anaphylaxis saves lives. An affected or at-risk person must be aware of possible triggers and early warning signs. If you are prone to these reactions, you must be familiar with the use of emergency kits and always have them with you. Emergency measures and prevention are central to management. As always, allergic diseases are best treated by avoidance measures, which will be reviewed in detail below.
EMERGENCY MEASURES FOR ANAPHYLAXIS
If you suspect that you or someone you are with is having an anaphylactic reaction, the following are important first aid measures. In general, try to perform these in the order that they are presented.
If available, inject epinephrine immediately. The shot is given into the outer thigh and can be administered through light fabric. Rub the site to improve absorption of the drug.
Call emergency services or 911 IMMEDIATELY.
For reactions to insect stings or allergy shots, place a tourniquet between the puncture site and the heart. Release it for a few seconds every 10 minutes.
Place a conscious person lying down and elevate the feet if possible.
Stay with the person until help arrives.
If trained, begin CPR if the person stops breathing or doesn’t have a pulse.
Allergy Assist
Shots of epinephrine can be given through light clothing such as trousers, skirts, or stockings. Heavy garments may have to be removed prior to injecting.
After 10 to 15 minutes, if the symptoms are still significant, you can inject another dose of epinephrine if available. Even after the reaction subsides, it is strongly advised that you go to an emergency room or allergist’s office immediately. Other treatments may be given, such as oxygen, intravenous fluids, breathing medications, and possibly more epinephrine. Steroids and antihistamines may be given but these are often not helpful initially and do not take the place of epinephrine. However, they may be more useful in preventing a recurrent delayed reaction.
Allergy Alert
Do not be surprised if epinephrine makes you feel shaky and causes a rapid, pounding pulse. These are normal side effects and are not dangerous except for those with severe heart problems.
Two situations deserve special attention at this point since they are not covered elsewhere but are particularly interesting.
Regarding the first situation, in the 1970’s, it was noted that exercise could cause anaphylaxis. Exercise-induced anaphylaxis (EIA) usually occurs with prolonged, strenuous exercise. Conditioned athletes such as marathon runners are frequently affected. The reaction may occur while exercising shortly after eating a meal, after eating specific foods (i.e. lettuce, shellfish, and celery) or after taking aspirin. It appears as though food or aspirin loads the gun and exercise pulls the trigger. Early symptoms are usually flushing and itching, which may progress to other typical symptoms of anaphylaxis if the exercise continues. Pre-medication with antihistamines or other drugs does not consistently prevent EIA. Exercise avoidance is the most effective treatment. If this is not feasible, exercising with a “buddy” and carrying emergency kits is mandatory.
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